Gastroenterology Coding Alert

Question: My gastroenterologist manually removed a percutaneous gastrostomy (PEG) tube from an established patient; this was a simple procedure done in-office. What can I report for this service?

California Subscriber

Answer: CPT does not include a procedure code for basic PEG tube removal. However, when your gastroenterologist removes a PEG tube manually with no complications, it is usually a level-two E/M service.
 
In your scenario, you should report 99212 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: a problem-focused history; a problem-focused examination; straightforward medical decision-making).
 
Exceptions: Before reporting this service, double-check the operative note, because you must know what technique the physician used to remove the tube. A physician can remove a PEG tube one of two ways: Certain types of tubes dictate endoscopic removal, while others are designed for manual removal in the office.
 
Also, if complications arise and the gastro can't remove the tube manually, he may have to perform an endoscopy to take the tube out.
 
If the gastroenterologist has to remove a PEG tube endoscopically, use code 43247 (Upper gastrointestinal endoscopy including esophagus, stomach and either the duodenum and/or jejunum as appropriate; with removal of foreign body).